Bromocriptine: Uses and Dosages
Bromocriptine is primarily used to treat hyperprolactinemia, Parkinson's disease, acromegaly, and type 2 diabetes mellitus, with dosages ranging from 1.25-100 mg daily depending on the indication. 1
Primary Indications and Dosing
1. Hyperprolactinemia/Prolactinomas
- Initial dose: 1.25-2.5 mg daily with food 1
- Titration: Increase by 2.5 mg every 2-7 days as tolerated
- Therapeutic range: 2.5-15 mg daily for adults 1
- Pediatric dosing (ages 11-15): 2.5-10 mg daily 1
- Note: Cabergoline is now preferred over bromocriptine for prolactinomas due to better efficacy and fewer side effects 2, 3
2. Acromegaly
- Initial dose: 1.25-2.5 mg at bedtime with food for 3 days 1
- Titration: Add 1.25-2.5 mg every 3-7 days based on clinical response
- Therapeutic range: 20-30 mg/day (typical optimal range) 1
- Maximum dose: 100 mg/day 1
- Monitoring: Monthly assessment of growth hormone levels to guide dosage adjustments
3. Parkinson's Disease
- Initial dose: 1.25 mg twice daily with meals 1
- Titration: Increase every 14-28 days by 2.5 mg/day
- Maximum dose: 100 mg/day 1
- Note: Often used as adjunctive therapy with levodopa
4. Type 2 Diabetes Mellitus (Quick-Release Formulation)
- Formulation: Quick-release (QR) bromocriptine (Cycloset™) 4
- Dosing: Up to 4.8 mg daily, administered in the early morning 4, 2
- Efficacy: Lowers HbA1c by 0.6-1.2% (7-13 mmol/mol) 4
- Mechanism: Acts centrally to reset circadian rhythms of hypothalamic dopamine and serotonin 4
5. Peripartum Cardiomyopathy (Investigational)
- Dosing regimen: 2.5 mg twice daily for 2 weeks, followed by 2.5 mg daily for 4 weeks 2
- Note: While promising in pilot studies, larger randomized trials are needed before routine recommendation 2
- Important safety measure: Anti-coagulation therapy is strongly recommended when using bromocriptine for PPCM due to thromboembolic risk 2
Administration Guidelines
- Take with food to minimize gastrointestinal side effects 1
- For hyperprolactinemia: Consider small nocturnal dose increments to reduce adverse effects 2
- For diabetes: Administer in early morning for optimal effect on circadian rhythms 4
- Frequent evaluation during dose escalation to determine optimal therapeutic response 1
Side Effects and Monitoring
Common Side Effects
- Gastrointestinal: Nausea, vomiting
- Neurological: Dizziness, headache
- Cardiovascular: Orthostatic hypotension 2
- Psychological: Mood changes, depression, impulse control disorders 2
Monitoring Recommendations
- Echocardiogram: At initiation of therapy and yearly surveillance for patients with prolactinoma 2
- Growth hormone levels: Regular monitoring for acromegaly patients 1
- Blood glucose: Regular monitoring for diabetic patients 4
Special Considerations
Pregnancy and Lactation
- Mechanical contraception recommended during treatment for hyperprolactinemia until normal ovulatory cycles return 1
- If menstruation does not occur within 3 days of expected date, discontinue bromocriptine and perform pregnancy test 1
- Bromocriptine has been used to stop lactation in postpartum women 2
Treatment Resistance
- For prolactinomas: Consider surgical intervention if dopamine agonist resistance occurs (defined as failure to achieve normal prolactin levels after 3-6 months of maximum tolerated dose) 2
- For acromegaly: Yearly withdrawal from therapy to assess disease progression and treatment effects 1
Clinical Pearls
- Bromocriptine is less effective than cabergoline for prolactinomas but remains a viable option 2
- The doses used for diabetes (≤4.8 mg) are much lower than those used for Parkinson's disease and have not been associated with retroperitoneal fibrosis or heart valve abnormalities 4
- When treating PPCM with bromocriptine, anticoagulation is essential due to thromboembolic risk 2
- Withdrawal of bromocriptine therapy is associated with reversal of its beneficial effects in most patients 5